Communication & Medicine, Vol 11, No 1 (2014)

Strategies of persuasion in offers to participate in cancer clinical trials I: Topic placement and topic framing

Ellen Barton, Susan Eggly, Andrew Winckles, Terrance L. Albrecht
Issued Date: 16 Mar 2015


Clinical trials are the gold standard in medical research evaluating new treatments in cancer care; however, in the United States, too few patients enroll in clinical trials, particularly patients from minority groups. Offering patients the option of a clinical trial is an ethically-charged communicative event for oncologists. One particularly vexed ethical issue is the use of persuasion in offers to participate in clinical trials. Based on a corpus of 22 oncology encounters with Caucasian-American (n=11) and African-American (n=11) patients, this discourse analysis describes oncologists’ use of two persuasive strategies related to the linguistic structure of the encounter—topic placement and topic framing. Findings are presented in total and by patient race, and discussed in terms of whether these strategies may constitute ethical or unethical persuasion, particularly with respect to the ethical issue of undue influence and the social issue of underrepresentation of minorities in cancer clinical trials.

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DOI: 10.1558/cam.v11i1.16614


Ainsworth-Vaughn, N. (2001) The discourse of medical encounters. In D. Schiffrin, D. Tannen and H. Hamilton (eds) The Handbook of Discourse Analysis, 453–469. Malden, MA: Blackwell.

Albrecht, T., Eggly, S., Gleason, M., Harper, F., Foster, R. and Peterson, A. (2008) Influence of clinical communication on patients’ decision making on participation in clinical trials. Journal of Clinical Oncology 26 (16): 2666–2673.

American Medical Association. (1998) Opinion 2.07 – clinical investigation. In AMA Code of Medical Ethics. Retrieved from

Banda, D., St. Germain, D., McCaskill-Stevens, W., Ford, J. and Swain, S. (2012) A critical review of the enrollment of black patients in cancer clinical trials. In ASCO [American Society of Clinical Oncology] 2012 Education Book, 153–157. Retrieved from

Barton, E. (2007) Institutional and professional orders of ethics in the discourse practices of research recruitment in oncology. In R. Iedema (ed.) The Discourses of Hospital Communication: Tracing Complexities in Contemporary Health Care Organizations, 18–38. New York: Palgrave Macmillan.

Barton, E. and Eggly, S. (2009) Ethical or unethical persuasion? The rhetoric of clinical trials offers. Written Communication 26 (3): 295–319.

Beauchamp, T. and Childress, J. (2001) Principles of Biomedical Ethics. Fifth edition. New York: Oxford University Press.

Brown, R. (2014) Physician–patient communication on clinical trials. In H. Hamilton and W. S. Chou (eds) The Routledge Handbook of Language and Health Communication, 614–628. New York: Routledge.

Brown, R., Butow, P., Butt, D., Moore, A. and Tattersall, M. (2004) Developing ethics strategies to assist oncologists in seeking informed consent to cancer clinical trials. Social Science and Medicine 58 (2): 379–390.

Brown, R., Butow, P., Ellis, P., Boyle, F. and Tattersall, M. (2004) Seeking informed consent to cancer clinical trials: Describing current practice. Social Science and Medicine 58 (12): 2445–2457.

Brown R., Bylund, C., Siminoff, L. and Slovin, S. (2010) Seeking informed consent to Phase 1 clinical trials: Identifying oncologists’ communication strategies. Psycho-Oncology 20 (4): 507–516.

Burke, N. and Barker, J. (2014) Health communication ‘noise’: Insights from medical anthropology. In H. Hamilton and W. S. Chou (eds) The Routledge Handbook of Language and Health Communication, 15–28. New York: Routledge.

Chafe, W. (2001) The analysis of discourse flow. In D. Schiffrin, D. Tannen and H. Hamilton (eds) The Handbook of Discourse Analysis, 673–687. Malden, MA: Blackwell.

Cheng, S., Dietrich, M. and Dilts, D. (2010) A sense of urgency: Evaluating the link between clinical trial development time and the accrual performance of cancer therapy evaluation program (NCI-CTEP) sponsored studies. Clinical Cancer Research 16 (22): 5557–5563.

Eggly, S., Albrecht, T., Harper, F., Foster, T., Franks, M. and Ruckdeschel, J. (2008) Oncologists’ recommendations of clinical trial participation to patients. Patient Education and Counseling 70 (1): 143–148.

Eggly, S., Barton, E., Winckles, A., Penner, L. and Albrecht, T. (2013) A disparity of words: Racial differences in oncologist–patient communication about cancer clinical trials. Health Expectations. E-publication ahead of print:

Ford, J., Howerton, J., Lai, G., Gary, T., Bolen, S., Gibbons, M., Tilburt, J., Baffi, C., Tanpitukpongse, T. P., Wilson, R. F., Powe, N. R. and Bass, E. B. (2007) Barriers to recruiting underrepresented populations to cancer clinical trials: A systematic review. Cancer 112 (2): 228–242.

Fouad, M. (2009) Enrollment of minorities in clinical trials: Did we overcome the barriers? Contemporary Clinical Trials 30 (2): 103–104.

Goss, E., Lopez, A., Brown, C., Wollins, D., Brawley, O. and Raghavan, D. (2009) American Society of Clinical Oncology policy statement: Disparities in cancer care. Journal of Clinical Oncology 27 (17): 2881–2885.

Jacobs, E., Mendenhall, E., McAlearney, A., Rolle, I., Whitaker, E., Warnecke, R. and Ferrans, C. E. (2011) An exploratory study of how trust in health care institutions varies across African American, Hispanic and white populations. Communication & Medicine8 (1): 89–98.

Kasper, D., Braunwald, E., Hauser, S., Longo, D., Jameson, J. and Fauci, A. eds. (2005) Harrison’s Principles of Internal Medicine. Sixteenth edition. New York: McGraw-Hill Medical.

Labov, W. (1972) The transformation of experience in narrative syntax. In W. Labov (ed.) Language in the Inner City, 354–396. Philadelphia, PA: University of Pennsylvania Press.

Mills, E., Seely, D., Rachlis, B., Griffith, L., Wu, P., Wilson, K., Ellis, P. and Wright, J. (2006) Barriers to participation in clinical trials of cancer: A meta-analysis and systematic review of patient-reported factors. Lancet Oncology 7 (2): 141–148.

Nass, S., Moses, H. and Mendelsohn, J. (2010) A National Cancer Clinical Trials System for the 21st Century: Reinvigorating the NCI Cooperative Group Program. Washington, DC: Institute of Medicine.

National Cancer Institute. (2014) SEER [Surveillance, Epidemiology, and End Results]. Retrieved April 2, 2014 from

National Commission for the Protection of Human Subjects in Biomedical and Behavioral Research. (1979) The Belmont Report. United States Department of Health, Education, and Welfare: Washington, DC. Retrieved from

National Comprehensive Cancer Network. (2014) Clinical trials. In Patient and Caregiver Resources. Retrieved from

National Institutes of Health. (2001 [1993]) NIH policy and guidelines on the inclusion of women and minorities as subjects in clinical research – amended October, 2001. In Grants & Funding. Retrieved from

Newman, L., Pollock, R. and Johnson-Thompson, M. (2003) Increasing the pool of academically oriented African-American medical and surgical oncologists. Cancer 97 (1 Supplement): 329–334.

Porter, R. (1997) The Greatest Benefit to Mankind: A Medical History of Humanity. New York: Norton.

Rivers, D., August, E., Sehovic, I., Green, B. and Quinn, G. (2013) A systematic review of the factors influencing African-Americans’ participation in clinical trials. Contemporary Clinical Trials 35 (27): 13–32.

Simon, C., Siminoff, L., Kodish E. and Burant, C. (2004) Comparison of the informed consent process for randomized clinical trials in pediatric and adult oncology. Journal of Clinical Oncology 17: (13): 2709–2717.

Street, R. and Gordon, H. (2008) Companion participation in cancer consultations. Psycho-Oncology 17 (3): 244–251.

Tannen, D. and Wallett, C. (1987) Interactive frames and knowledge schemas in interaction: Examples from a medical examination/interview. Social Psychology Quarterly 50 (2): 205–216.

Washington, H. (2006) Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. New York: Doubleday.


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